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Flying Syringes Deliver Ethical Questions

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Reviewing the list of the electives offered for the upcoming trimester, I noticed an interesting class, Entrepreneurial Science Biotech Research & Development, in which students run a virtual biotechnology company. The project the students promote in the class is called the “Flying Syringe,” which proposes the usage of genetically modified mosquitoes to inject vaccines upon biting their hosts in order to promote vaccination in developing countries. It was clearly an ingenious solution to a recalcitrant problem. Due to lack of medical infrastructure, several areas in the world remain susceptible to diseases (including West Nile virus, malaria, and cholera) that immunization has effectively eradicated elsewhere. These mosquitoes could be the solution. But are they really?

The difficulty is that this seemingly ethical and humanitarian project, poised to save millions of lives, in fact lacks perhaps one of the most important elements in medical care: consent. The Nuremberg Code, a set of ethical rules that physicians must follow, states that, “The voluntary consent of the human subject is absolutely essential.” Countless countries and institutions have enshrined this principle in their codes of conduct.

Increasingly, countries and states are passing mandatory vaccination laws that have resulted in contentious debates. However, the word “mandatory” has a different weight when used in reference to flying agents. In the more classical forms of vaccination, one can still dodge the mandatory requirement at the cost of societal benefits such as enrollment in school and employment. But if the state were to apply the mandatory vaccination through mosquitoes, the option of avoiding the vaccination would become truly impossible and the element of consent would therefore be completely absent. This raises the question of the significance this last vestige of consent threatened with elimination by the mosquito vaccination plan.

There are already several ways in which the state can exercise power over its citizens’ health without any form of direct individual consent. These include the chemicals that go into the water supplies and the pesticides spread around towns, practices which are often determined democratically by the state rather than by asking for consent individually from the entire population, which would, of course, be very difficult. But if the state can already intervene indirectly with the substances the population is exposed to, in what sense would a more direct intervention such as using mosquito vaccines be different?

The significance and meaning of consent is further challenged when considering the weight of the issue that the technology is trying to solve. Malaria, one of the diseases that the project could combat, killed 627,000 in 2013 alone, mostly children in Africa. How do we weigh the notion of consent against the severity of the disease? On the one hand, consent is an extremely significant principle dramatically reinforced in the 20th century by the tragedy of the Nazi experiments. On the other hand, diseases are continuing to kill large numbers of children everyday. This perhaps suggests that consent is simply a luxurious idea for the well-off. One point of view might hold that children at risk are more concerned about surviving until the next night than consenting to a vaccination. However, ignoring consent to solve a public health challenge could set a dangerous precedent, especially as it is difficult to scrutinize the severity of the issue required for consent to be ignored.

Flying syringes can be differentiated by the expression of GFP in the salivary gland, which causes transgenic mosquitos to glow green

Flying syringes can be differentiated by the expression of GFP in the salivary gland, which causes transgenic mosquitos to glow green (Figure from http://www.lib.okayama-u.ac.j/www/acta/pdf/64_4_233.pdf)

Furthermore, the technology itself presents problems. Because mosquitoes are delivering the vaccines, the caution and rules that are followed by people who administer the vaccine are absent. Vaccines given to babies too early are often ineffective and could deter subsequent development of immunity. Every vaccine also has a side effect that varies in degree, creating the possibility that individuals could be harmed by supposed health care to which they did not consent. No organization or country has the right to take a risk on another’s behalf, especially considering the directness of the therapy and the gravity of the medical consequences. Until the technology is perfected, the project cannot be considered further.

One fact to be noted is that 77% of deaths from Malaria occur in children under the age of 5. The parents of these children are often not in a position to provide them medical care and health support. In this case, the state or another organization may invoke the idea of acting in loco parentis and assume the responsibility of the children. This leads to the consideration of a troubling dilemma, that is, how do we set the line according to which another organization could take responsibilities of the parent? It is difficult to conceive how we could even begin to answer this question.

While ultimately I did not join the elective, it certainly triggered my investigation. Before we can consider the ethical implications, we must confirm that the technology in question is an effective and a realistic one. But even under the premise that the technology presents no lasting medical difficulties, we must remain extremely cautious about the consequences of ignoring consent. Indeed, the problem of the disease is significant, but the notion of medical treatment without consent could set a still more troubling example for the future.

Additional Links:

Flying Syringes project receives grant from Bill Gates: http://www.washingtonpost.com/wp-dyn/content/article/2008/10/22/AR2008102203083.html

The BCA Flying Syringe crowdfunding page: https://www.rockethub.com/projects/40380-bergen-county-academies-the-flying-syringe

Paper of the flying syringes project by the original scientists: http://www.lib.okayama-u.ac.jp/www/acta/pdf/64_4_233.pdf

 

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Flying Syringes Deliver Ethical Questions